How Americans talk about health care reform

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The hazy, hot and humid days of summer led me to take some time off from blogging to go camping, and even catch Taylor Swift in concert at Gillette Stadium. Now that the heat wave is past, and cooler days and nights have arrived, it’s time to catch up on recent discussions of health insurance premiums. In July, I had a chance to sit down with Chrissy Centazzo from the PC Public Affairs office to chat about the debut of Rhode Island’s health insurance exchange, HealthSource RI. In recent weeks, President Obama and many state officials trumpetedlower than expected premiums for health insurance offerings under the new health insurance exchanges in states such as California, Maryland, Oregon, Tennessee, and Virginia, among others. Defenders of the ACA argue that premiums will be more affordable for uninsured families, and small businesses and individuals who will purchase coverage through the exchanges. The long term success of the ACA in expanding coverage and controlling costs, however, depends on signing up healthy young subscribers.

Selling the plans, however, will be a challenge. While projected premiums are lower than many forecasts, coverage through the state exchanges is not cheap. As Louise Radnofsky noted, individual premiums for twenty-five year olds who don’t smoke ranged from $117 per month in Tennessee to $156 per month in Baltimore. Will cash-strapped consumers opt to purchase coverage at an annual cost of at least $1400, or will they continue to rely on safety net providers and hospital emergency rooms for care? Since the annual penalty for not purchasing coverage ($95) is less than the cost of one month of the most affordable health insurance on the market, how many healthy young adults will choose to pay substantially more to purchase coverage, particularly when the “Bronze” level plans impose significant cost sharing for newly insured subscribers? As the Fall enrollment season approaches, both supporters and opponents of ACA will weave stories to define the success or failure of the individual mandate. Stay tuned… the debate over ObamaCare has just begun…

Every author has a backstory that can place his or her work in context. Recently, I had an opportunity to discuss the goals and origins of my new book, Cries of Crisis, with Chris Machado, the academic communications director at Providence College, as part of the PC library’s new Faculty Authors series.

Check out the streaming video of our conversation for an overview of my arguments, including the shortcomings of crisis narratives as a diagnosis for what ails the US health care system and the unintended “side effects” of crisis rhetoric for health care reform. Many thanks to Hailie Posey, Mark Caprio, and Chris Landry for producing this.

In recent weeks, warnings that America will soon drive off a “fiscal cliff” sparked renewed calls for entitlement reform. Forging an agreement on a long-term deficit reduction plan will require policymakers to make difficult choices about controlling health care costs. Rising costs for Medicare and Medicaid—coupled with new subsidies for millions of Americans to purchase private health insurance through health exchanges beginning in 2014—will contribute to steadily increasing federal spending on health care over the next decade. Nevertheless, a “fix” for rising health care costs continues to elude policymakers. Indeed, public deliberations about controlling health care costs offer a remarkable sense of déjà vu. Warnings of an impending cost crisis—and a corresponding need for decisive action to rein in health care spending—have shaped each debate over health care reform since the early 1970s.

Advocates for cost control must recognize that the public views health care spending as both a bane and a blessing. For most of the 20th century, spending on health care was defined as a worthwhile investment. Opponents of reform raised concerns about the consequences of cost controls and portrayed additional spending as the price of medical progress. Health providers and patient advocacy groups pointed to the fruits of continued medical innovation that paid dividends in the form of better health, improved quality of life, and longer life expectancy for millions of Americans. From this vantage point, the “side effects” of controlling health care costs were worse than the disease itself. For those who regard additional spending on health care as an investment, high health care costs are a social choice, not a crisis.

Every year, millions of Americans join together in “walks for cures” to raise money for medical research and treatments, and tens of millions of Americans purchase bracelets or don colored ribbons to express their support for continued medical progress. In addition, spending on health care provides jobs and income for millions of Americans who work in an industry that now represents nearly one fifth (18%) of the U.S. economy. Since costs for one group represent income for others, the health care cost crisis is ultimately a matter of perspective. Patients and purchasers of care decry rising expenditures, but these costs represent income for providers, a source of economic growth for many communities, and hope for patients and families struggling with illness.

In crafting a solution to the fiscal cliff, policymakers must recognize that despite decades of crisis talk, consumers continue to press for more generous health insurance coverage and additional services, not less.

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Reviews

Midwest Book Review, December 2012:

"The overuse of anything will cause the public become desensitized to it... [Hackey] believes the idea of a persistent healthcare crisis has hurt the rationality of the debate, and has lost sight of many of the problems that lie at the roots of the problem, and is hurting the push for better reform. Offering a very different perspective on healthcare issues, "Cries of Crisis" is a strong addition to any social issues debate collection, much recommended."